Forced first intercourse common, leaves behind long-term health scars

By Dr. Liji Thomas, MDSep 17 2019

A harrowing new study published on September 17, 2019, in the journal JAMA Internal Medicine, reports that over 3 million women in the US were introduced to sex via rape, cutting across all social groups. This corresponds to about 6.5% of women. The odds of resulting or accompanying conditions was calculated and found to be significantly higher in this group compared to women in this age group who had voluntary first intercourse.

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Characteristics surrounding the encounter

Rape is a sexual encounter that is unwanted or nonconsensual, according to law. The current study classifies all physically forced and unwanted events surrounding first sexual intercourse as forced sexual initiation, a separate category of rape. The average age of the victims was 15.6 years, compared with 17.4 for women who voluntarily had a first sexual experience. The assailants were, on average, 6 years older than their victims.

In about half the cases, the rapist was physically bigger or older, and held down the women. Intimidatory or coercive words were used in 56% of cases, physical threats in a quarter, and actual physical harm occurred in another quarter. Over one in five women reported that they were drugged at the time. In many cases multiple forms of force were used, as threats and violence together.

One revealing finding is that emotional coercion, such as threatening to end a relationship if the female partner refuses to have sex, and verbal coercion, is a source of significant trauma to women, comparable to actual physical violence. On the other hand, the study also shows that this is not generally recognized and such women are not given sympathy or help, unlike others who have suffered physical harm. This results in their feeling “more shamed, isolated and traumatized,” according to researcher Alison Huang.

Psychosocial and health sequelae

Problems linked to sexual violence may arise quite early in life, and continue to show up over time. The long-term complications of the rape were manifold, including higher rates of HIV infection and other sexually transmitted infections (STIs), pelvic inflammatory disease (PID), and issues related to fertility and menstruation including endometriosis. Unwanted pregnancy occurred in over 30% of these women, and over 24% of them had at least one abortion, which is higher than the rate among those who had voluntary first sexual intercourse. Three times as many women in this group reported that physical or mental ill health prevented them from fulfilling one or more types of work compared to the controls. Chronic painful gynecologic and pelvic conditions were strongly linked to such a history. Health was reported to be only fair or poor twice as often in this group as in the control group.

Earlier studies reported about 40% incidence of sexual violence at some point in the lifetime of all women, and a 20% incidence of rape. However, there is less recent information on how many women have experience rape as their introduction to sex. The current study includes over 13 000 women aged 18 to 44 years, and used data from the National Survey of Family Growth, over the period 2011 to 2017. Researchers expect a still higher incidence – “many millions higher,” according to fellow researcher Laura Hawks – if all women are included, especially since most of the rapes occurred in adolescence. The increased level of openness about sexual violence that has set in recently will also increase reporting of such events, contributing to higher incidence rates.

The researchers conclude that doctors typically overlook this association between health problems and sexual violence, though they are likely to see several patients with a history of forced sexual initiation each week. They advise the development of tools to help physicians identify and help such people in a sensitive manner. “We should really become better practitioners of trauma-informed care, which is a practice of incorporating exposure to prior trauma experienced by the patient into the treatment plan,” says Hawks.